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TOPLINE:

A study of older adults found that 59% experienced slight decline in cognition and 15% experienced severe decline over 6 years after major elective noncardiac surgery. 

METHODOLOGY:

• Researchers analyzed data from a prospective cohort (SAGES) to identify the patterns of long-term cognitive outcomes in older adults after major surgery.
• They included 560 patients aged 70 years or older (average age, 76.7 years; 58% women) who were free of dementia and underwent major elective noncardiac surgery at two Boston hospitals between June 2010 and August 2013.
• Cognition was evaluated using the general cognitive performance (GCP) score, which combined results from multiple tests and was adjusted using data from 119 participants who did not undergo surgery.
• The primary outcome was a change in the GCP score, assessed at 11 timepoints over up to 6 years.
• Researchers classified patients into three trajectories: severe decline, showing an early drop in GCP and ongoing worsening; slight decline, marked by a minimal initial dip in GCP followed by recovery and then a slow decline; and stable, characterized by some early improvement in GCP with no lasting decline.

TAKEAWAY:

• Overall, 15% of patients experienced severe cognitive decline, 59% had slight decline, and 26% had stable cognition.
• Delirium occurred in 24% of the cohort and was more common in patients with severe decline in cognition (46%) than in those with slight decline (21%) or those who remained stable (18%).
• Patients who developed delirium after surgery had more than twice the risk for severe decline in cognition than those who did not develop delirium (adjusted relative risk [aRR], 2.15; 95% CI,1.35-3.42).
• Presurgical factors associated with severe decline in cognition were older age (aRR, 1.06 per year; 95% CI, 1.03-1.10) and lower baseline score for cognition (aRR, 0.95 per point; 95% CI, 0.92-0.99). 

IN PRACTICE:

“If validated in future studies, our findings provide valuable prognostic information for older patients contemplating surgery and their clinicians, and identify vulnerable patients who may benefit from interventions, including delirium prevention,” the researchers of the study wrote.

SOURCE:

The study was led by Nancy Lu, MD, of Harvard Medical School in Boston. It was published online on May 16 in the Journal of the American Geriatrics Society.

LIMITATIONS:

The three trajectory groups were statistical constructs, not clinical diagnoses. Researchers could not determine true cognitive trends because only one preoperative GCP score was available.

DISCLOSURES:

The study received support from grants from the National Institute on Aging. One author reported serving as Editor in Chief of JAMA Internal Medicine and holding the Milton and Shirley F. Levy Family Chair at Hebrew Senior Life/Harvard Medical School. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.